Education and Health Care: The Business Model is the Wrong Model
This is largely a repeat from June last year. Now that we have a new President, it might be worth reviewing the topic.
During the Bush years, and here in NYC under Bloomberg, there has been a tendency to take control of health care and education away from individuals and increasingly run them on what is generally called a "business model." Bloomberg makes this explicit by saying he wants to run the city like a CEO then behaving like a dictator. Government is not a business. In some cases running a government in a manner parallel to a business can work, as long as people keep in mind that they are not the same thing and do not have the same goals. Two areas where this so-called "business model" fails particularly badly are in education and health care. In NYC mayoral control intends to put our schools under control of this kind of "business model." It is time to abandon this mistaken idea.
First, my bias from when I first moved to NYC in 1998 is that, of all the cities I have lived in, I have never seen a city with such a dictatorial mayor's office and comparatively ineffectual city council as what I see in NYC. This impression has only increased. So mayoral control struck me as just one more power grab by an already excessively powerful mayor with inadequate checks and balances. Supposedly the city council and the Public Advocate's office are checks and balances on the mayor. Well, so far I have not been impressed with the performance of either in this regard.
My wife and I then got to experience the early iterations of Bloomberg's ever reorganized education system. The excessive testing and the insane Middle School application process were what I found most flawed with his system. I am not against testing. In fact I see it as critical, unlike many of my progressive colleagues. But there is a such thing as TOO much testing because then education fails to teach thinking and analytical skills and only teaches the material needed for the next test, an ineffective education technique. This was the situation we saw our daughter go through up to 6th grade. We also got to experience a Middle School applications process that does little except cause massive anxiety among students and parents, requires so much commitment during business hours by parents that working class parents are unable to effectively navigate the system, and which requires preteens to shuttle all over the city just to get to school. My daughter eventually tested into Hunter High School, so we are now shielded from the mayor's control of her education and what apparently is even MORE testing: once every six weeks I now hear.
My wife and I realize that the system wasn't great before. But what Bloomberg has done is to make it almost impossible for education itself to take a front seat. Administration and testing are by far the main focus of his system, with education low on the priority list. You cannot have a functioning democracy or a high tech economy with an inadequate education system.
It seems to me there are two fundamental reasons why Bloomberg's mayoral control is wrong. Both stem from the fact that Bloomberg is using a business model as the basis for his education reform. The first problem is that his reforms so far fail even as a business model since any business run the way he has run the education system would be out of business in no time. Second, the business model is completely inappropriate for critical social services like education and healthcare and essentially fails when compared with more, yes, I'll say it, socialized systems.
First off, mayor Bloomberg's reorganization of the schools would fail the business model even if a business model could work for education. Among the issues brought up at a forum I attended in June 2008 and also brought up by teachers we know as well as our daughter up to 6th grade are: textbooks that are out dated and not available in an adequate supply; testing of students as a way to evaluate the school's performance every six weeks; insufficient numbers of desks and chairs; schools where bathrooms are locked all day; exclusion of teachers, students and parents from the decision making process. That's just to name the ones that struck me the most. Let me ask you this: do you think a business that adopted this plan for success would last? Of course not. What is described by participants within the New York school system is a "business" where the facilities are inadequate and poorly maintained, workers (teachers) and customers (parents and teachers) are treated poorly, three reorganizations have happened to date since inception, workers have performance evaluations every six weeks, and raw materials (textbooks) are in inadequate supply. Furthermore, the acceptable performance rating is low. No business could run that way. None. Even a sweatshop can't treat its customers that badly, reorganize practically every year, and have inadequate supplies of raw materials! The most successful businesses would look at Bloomberg's performance as CEO of the school system and throw his resume in the trash.
Bloomberg is a failed CEO if the school system is to be judged based on the business model. But let's consider whether the business model is even appropriate.
The business model assumes competition among rival entities with some that will fail and some that will succeed. Those that succeed are rewarded by the "market" and those that fail are weeded out.
How can either a healthcare or an education system be based on a theory wherein failure is a necessary part of the evolution of the system. We are assuming that some of our kids will receive an inadequate education and fail out on the assumption that maybe we can then weed out the bad schools and do better next generation. Ummm, hello! What happened to the idea that a quality education needs to be available to all citizens in order for a democracy to survive? And consider applying that same concept to healthcare. Litterally death of the patient due to inadequate care becomes part of the system. So your uncle Fritz died because he wasn't given the right diagnostic analysis? Oh well, too bad. Maybe we can close down that hospital and do better on a another patient. My wife's experience has been that the proper diagnostic tools are not made available because they are not covered by insurance, so treatment is geared not to the individual patient but rather to the average patient. You hace to wait weeks to get an appointment for even this inadequate care.
It is absurd!
But we don't have to stick with theory. Let's actually look at how the American business model for healthcare measures up to the more socialized systems. I have written about this before and I admit my figures are still from 2005. But here is how we measure up using some standard measures of national health (more details in the linked article):
The US ranks 29th for healthy life expectancy. That is right between Slovenia and Portugal. Keep in mind, America is a far wealthier nation than EITHER Slovenia or Portugal, yet our healthy life expectancy is only 69.3 years. Slovenia beats us slightly with 69.5. UK, with a more socialized system, ranks 24th. Netherlands with a more socialized system ranks 18th. Canada, the system Republicans most like to denigrate when nationalized health care is suggested, ranks 11th. Sweden, which is almost synonymous with socialized health care, ranks 3rd with 73.3 years. We are beaten by nations with much lower levels of wealth (like Slovenia and Italy and Greece). I hear Republicans today complain that Democrats want to make America more like Sweden. Okay, so I don't like ABBA either, but I do think we should pay attention to the nation that has the third best healthy life expectancy.
How about the probability of not reaching 60 years old? In the US there is a 12.8% chance of not reaching 60 years old. That is slightly better than Portugal and slightly worse than Albania. Again, we are far wealthier than Portugal or, for god's sake, Albania (a nation even my Bulgarian co-worker considers poor), but that is where we rank. In "socialist" Sweden, a person has only an 8% chance of not reaching 60 years of age. Canada, the UK and the Netherlands all rank better than us on this measure as well.
How about the probability dying before 5 years old (female): United States: 8 per 1000 people. Interestingly, that is identical to the rate for Cuba. Yes...we rank right with Cuba. The Republican bugbear, Sweden, again outdoes us, with 3 per 1000 people. Canada is in between with 5 per 1000 people.
How about Respiratory disease child death rate: we are at 40.43...similar to Syria, the Philippines, Armenia, North Korea, and Khazakstan. Canada is at 0.62, Japan at 1.52, Netherlands at 0.88, Sweden at 1.03 and United Kingdom at 1.78.
Intestinal diseases death rate: United States is at 7.35%, right between Tunisia and Bosnia and Herzegovina. Canada is at 0.3%, Netherlands at 0.28%, Sweden at 0.39%...interestingly Poland and Greece do best. Not sure why, but we still are not getting our money's worth!
It goes on. I am not saying our health care is the worst in the world. Far from it. But when our peers for healthcare are Bosnia, Albania, North Korea and Cuba, perhaps it is time America start to emulate those at the top: Canada, Sweden, Netherlands etc.
Also keep in mind that Americans SPEND more on health care than most of the nations mentioned that outperform us. We pay more for a worse outcome. That is, by any business model definition, a failure. Is that how we want to approach education as well? And I haven't even addressed the inequities in our system, another major flaw.
The business model has never proven itself to be an appropriate model for healthcare or education. Bloomberg not only fails as CEO of our schools, but he is also dead wrong is even WANTING to be the CEO of our schools. We do not need a CEO. We need textbooks, teachers and class space.
I have watched two schools systems (California and New York) go through many changes, and there is only one constant that I have seen. When schools get lots of money, they excel. When school budgets are cut, the schools decline. Money is by no means the only factor. But nothing else works UNLESS the schools are well funded. Amply funded. The worst that can happen if you overfund schools is you wind up with the best schools around, as long as you aren't doing anything blatantly stupid in other ways like teaching creationism or teaching abstinence only, or not testing students at all. Testing is a necessary part of evaluating education. But money is by far the most important factor. Money for teachers, money for textbooks, money for desks, money for field trips, money for after school and pre-K programs. You want a healthy democracy and a competitive high tech economy? Put the damned money into the schools and ditch the failed business model for something more appropriate. The business model is for banking and selling shoes, not teaching our kids or healing our sick.
During the Bush years, and here in NYC under Bloomberg, there has been a tendency to take control of health care and education away from individuals and increasingly run them on what is generally called a "business model." Bloomberg makes this explicit by saying he wants to run the city like a CEO then behaving like a dictator. Government is not a business. In some cases running a government in a manner parallel to a business can work, as long as people keep in mind that they are not the same thing and do not have the same goals. Two areas where this so-called "business model" fails particularly badly are in education and health care. In NYC mayoral control intends to put our schools under control of this kind of "business model." It is time to abandon this mistaken idea.
First, my bias from when I first moved to NYC in 1998 is that, of all the cities I have lived in, I have never seen a city with such a dictatorial mayor's office and comparatively ineffectual city council as what I see in NYC. This impression has only increased. So mayoral control struck me as just one more power grab by an already excessively powerful mayor with inadequate checks and balances. Supposedly the city council and the Public Advocate's office are checks and balances on the mayor. Well, so far I have not been impressed with the performance of either in this regard.
My wife and I then got to experience the early iterations of Bloomberg's ever reorganized education system. The excessive testing and the insane Middle School application process were what I found most flawed with his system. I am not against testing. In fact I see it as critical, unlike many of my progressive colleagues. But there is a such thing as TOO much testing because then education fails to teach thinking and analytical skills and only teaches the material needed for the next test, an ineffective education technique. This was the situation we saw our daughter go through up to 6th grade. We also got to experience a Middle School applications process that does little except cause massive anxiety among students and parents, requires so much commitment during business hours by parents that working class parents are unable to effectively navigate the system, and which requires preteens to shuttle all over the city just to get to school. My daughter eventually tested into Hunter High School, so we are now shielded from the mayor's control of her education and what apparently is even MORE testing: once every six weeks I now hear.
My wife and I realize that the system wasn't great before. But what Bloomberg has done is to make it almost impossible for education itself to take a front seat. Administration and testing are by far the main focus of his system, with education low on the priority list. You cannot have a functioning democracy or a high tech economy with an inadequate education system.
It seems to me there are two fundamental reasons why Bloomberg's mayoral control is wrong. Both stem from the fact that Bloomberg is using a business model as the basis for his education reform. The first problem is that his reforms so far fail even as a business model since any business run the way he has run the education system would be out of business in no time. Second, the business model is completely inappropriate for critical social services like education and healthcare and essentially fails when compared with more, yes, I'll say it, socialized systems.
First off, mayor Bloomberg's reorganization of the schools would fail the business model even if a business model could work for education. Among the issues brought up at a forum I attended in June 2008 and also brought up by teachers we know as well as our daughter up to 6th grade are: textbooks that are out dated and not available in an adequate supply; testing of students as a way to evaluate the school's performance every six weeks; insufficient numbers of desks and chairs; schools where bathrooms are locked all day; exclusion of teachers, students and parents from the decision making process. That's just to name the ones that struck me the most. Let me ask you this: do you think a business that adopted this plan for success would last? Of course not. What is described by participants within the New York school system is a "business" where the facilities are inadequate and poorly maintained, workers (teachers) and customers (parents and teachers) are treated poorly, three reorganizations have happened to date since inception, workers have performance evaluations every six weeks, and raw materials (textbooks) are in inadequate supply. Furthermore, the acceptable performance rating is low. No business could run that way. None. Even a sweatshop can't treat its customers that badly, reorganize practically every year, and have inadequate supplies of raw materials! The most successful businesses would look at Bloomberg's performance as CEO of the school system and throw his resume in the trash.
Bloomberg is a failed CEO if the school system is to be judged based on the business model. But let's consider whether the business model is even appropriate.
The business model assumes competition among rival entities with some that will fail and some that will succeed. Those that succeed are rewarded by the "market" and those that fail are weeded out.
How can either a healthcare or an education system be based on a theory wherein failure is a necessary part of the evolution of the system. We are assuming that some of our kids will receive an inadequate education and fail out on the assumption that maybe we can then weed out the bad schools and do better next generation. Ummm, hello! What happened to the idea that a quality education needs to be available to all citizens in order for a democracy to survive? And consider applying that same concept to healthcare. Litterally death of the patient due to inadequate care becomes part of the system. So your uncle Fritz died because he wasn't given the right diagnostic analysis? Oh well, too bad. Maybe we can close down that hospital and do better on a another patient. My wife's experience has been that the proper diagnostic tools are not made available because they are not covered by insurance, so treatment is geared not to the individual patient but rather to the average patient. You hace to wait weeks to get an appointment for even this inadequate care.
It is absurd!
But we don't have to stick with theory. Let's actually look at how the American business model for healthcare measures up to the more socialized systems. I have written about this before and I admit my figures are still from 2005. But here is how we measure up using some standard measures of national health (more details in the linked article):
The US ranks 29th for healthy life expectancy. That is right between Slovenia and Portugal. Keep in mind, America is a far wealthier nation than EITHER Slovenia or Portugal, yet our healthy life expectancy is only 69.3 years. Slovenia beats us slightly with 69.5. UK, with a more socialized system, ranks 24th. Netherlands with a more socialized system ranks 18th. Canada, the system Republicans most like to denigrate when nationalized health care is suggested, ranks 11th. Sweden, which is almost synonymous with socialized health care, ranks 3rd with 73.3 years. We are beaten by nations with much lower levels of wealth (like Slovenia and Italy and Greece). I hear Republicans today complain that Democrats want to make America more like Sweden. Okay, so I don't like ABBA either, but I do think we should pay attention to the nation that has the third best healthy life expectancy.
How about the probability of not reaching 60 years old? In the US there is a 12.8% chance of not reaching 60 years old. That is slightly better than Portugal and slightly worse than Albania. Again, we are far wealthier than Portugal or, for god's sake, Albania (a nation even my Bulgarian co-worker considers poor), but that is where we rank. In "socialist" Sweden, a person has only an 8% chance of not reaching 60 years of age. Canada, the UK and the Netherlands all rank better than us on this measure as well.
How about the probability dying before 5 years old (female): United States: 8 per 1000 people. Interestingly, that is identical to the rate for Cuba. Yes...we rank right with Cuba. The Republican bugbear, Sweden, again outdoes us, with 3 per 1000 people. Canada is in between with 5 per 1000 people.
How about Respiratory disease child death rate: we are at 40.43...similar to Syria, the Philippines, Armenia, North Korea, and Khazakstan. Canada is at 0.62, Japan at 1.52, Netherlands at 0.88, Sweden at 1.03 and United Kingdom at 1.78.
Intestinal diseases death rate: United States is at 7.35%, right between Tunisia and Bosnia and Herzegovina. Canada is at 0.3%, Netherlands at 0.28%, Sweden at 0.39%...interestingly Poland and Greece do best. Not sure why, but we still are not getting our money's worth!
It goes on. I am not saying our health care is the worst in the world. Far from it. But when our peers for healthcare are Bosnia, Albania, North Korea and Cuba, perhaps it is time America start to emulate those at the top: Canada, Sweden, Netherlands etc.
Also keep in mind that Americans SPEND more on health care than most of the nations mentioned that outperform us. We pay more for a worse outcome. That is, by any business model definition, a failure. Is that how we want to approach education as well? And I haven't even addressed the inequities in our system, another major flaw.
The business model has never proven itself to be an appropriate model for healthcare or education. Bloomberg not only fails as CEO of our schools, but he is also dead wrong is even WANTING to be the CEO of our schools. We do not need a CEO. We need textbooks, teachers and class space.
I have watched two schools systems (California and New York) go through many changes, and there is only one constant that I have seen. When schools get lots of money, they excel. When school budgets are cut, the schools decline. Money is by no means the only factor. But nothing else works UNLESS the schools are well funded. Amply funded. The worst that can happen if you overfund schools is you wind up with the best schools around, as long as you aren't doing anything blatantly stupid in other ways like teaching creationism or teaching abstinence only, or not testing students at all. Testing is a necessary part of evaluating education. But money is by far the most important factor. Money for teachers, money for textbooks, money for desks, money for field trips, money for after school and pre-K programs. You want a healthy democracy and a competitive high tech economy? Put the damned money into the schools and ditch the failed business model for something more appropriate. The business model is for banking and selling shoes, not teaching our kids or healing our sick.
posted by mole333 | 10:17 PM
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1 comments
1 Comments:
Health care reform will be the topic of News Talk Online on Paltalk.com Thursday March 5 at 5 PM New York time.
You can connect to the conversation via my blog at http://www.garybaumgarten.com
Thanks,
Gary
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